389 Fork Bixby Rd (3) DAVIE COUNTY HEALTH DEPARTMENT 3 �p
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name V t c e t.� Date - (a - 91 No 629-4.
Location �_ RY �,� c\. V p,
SubdivisionName Lot No. Sec. or Block No.
Lot Size 1_`1.13 House -.Mobile Home �/� Business Speculation
A-
No. Bedrooms No. ,Baths No. in Family
Garbage Disposal YES [3 NO p' 'r` Specifications •for System:
Auto Dish Washer YES ❑7�- NO p-- f z: O o o
C,
Auto Wash Ma.hine YES p-1 NO ❑
Type Water Supply
*This permit Void if sewage system described'below is not installed within 5 years from date of issue.
This,permit is subject to revocation if site plans or the intended use change.
Y
-
4
Improvements per by� s
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installed by
bo
Fall
Certificate of Completion '�� _ Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
U
DAVIE COUNTY HEALTH DEPARTMENT 4
-..; "IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name- i r. :: n t Date l.� ` j' NO 6294.
Location �'+ '- '-'r `�q _ �l f; �� ,. �.1 th ,` 0 0
Subdivision-Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. BedroomsNo. in Family
No. Baths ti
_ � _
Garbage Disposal YES ❑ NO Er I
Specifications for System:
Auto Dish Washer. YES p', .NO a0c, ..�_
Auto Wash Ma.hine YES Q' NO ❑ t� c> t. ` a `` ' �'�`'�
Y
Type Water Supply
*This,permit Void if sewage system described below is not installed within 5 years from date of issue.
This,-permit is subject to revocation if site plans or the intended use change.
i
4 r
S— 4
13
Q i
`,t 4 t
Improvements permit by
J
*Contact a representative of the Davie County HealthµDepartment fob final inspection of this' system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985.
j I
Final Installation Diagram: System Installed by -�� -�-:
5411 _. _._�.. ', b
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT I �' U0 .kku
Davie County Health Department v
Environmental Health Section 'vED FCS 2
P. 0. Box 665 Cf
Mocksville, NC 27028 IRE-
1 . Application/Permit Requested By /1,d&Q,
Mailing Address a 9V/)
Home Phone qC\ �.� �.� BtK34 C> Phone 0XM q 4,��D
2. Name on Permit if Different than Above
3. Property Owner if Different than Above ". Wyu 00M-U' A 101�
4. Application/Permit For: lC) General Evaluation J• S/Tank Installation
5. System to Serve: HouseMobile Home 0 Business
Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions 1`), -K ea-L5
No. of Bedrooms1 Basement/Plumbing
No. of Bathrooms 1 Basement/No Plumbing
0 Washing Machine-1T1��� J Dishwasher 0 Garbage Disposai
7. If business, industry, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers
8. Type of water supply: V Public p Private 0 Community
9. Property Dimensions 1 act X--S
10. Sewage Disposal Contractor `l J wit rt r� I
11 . Do you anticipate additions/expansions of the facility this system is
intended to serve? [] Yes No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5
years from date issued. Improvements Permits are subject
to revocation, if site plans or the intended use change.
Effective October 1, 1989.
This is to certify that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
11 a
0 -A10
Date Signature
Directions to Property : �9
V .
DCHD (10-89)
7 '
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME NI C_ DATE EVALUATED
ADDRESS PROPERTY SIZE ZI + 12
PROPOSED FACIILTY LOCATION OF SITEyh P
Water Supply: On-Site Well Community Public
Evaluation By:C_�,L Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position S S
Slope Z A - &° O -£s" - o O
HORIZON I DEPTH L `'
Texture group S C S C S C
Consistence FTS
Structure
Mineralogy
HORIZON II DEPTH 2" u' C'
Texture group
Consistence IF �3
Structure C
Mineralogy1 :1 1!► /;/
HORIZON III DEPTH
Texturegroup
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS S S$ S S S
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION S $ S S
LONG-TERM ACCEPTANCE RATEI -,y0 ,
SITE CLASSIFICATION: S EVALUATED BY:
LON G-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS: S
EGEND
Landscape Position
R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope
Texture
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Silty clay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineraloey
1:1. 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water'or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD(O1-901
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